[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 3165 Introduced in Senate (IS)]

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118th CONGRESS
  1st Session
                                S. 3165

  To help persons in the United States experiencing homelessness and 
significant behavioral health issues, including substance use disorder, 
  by authorizing a grant program within the Department of Health and 
  Human Services to assist State and local governments, continuums of 
  care, community-based organizations that administer both health and 
homelessness services, and providers of services to people experiencing 
homelessness, better coordinate health care and homelessness services, 
                        and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            October 30, 2023

Mr. Padilla (for himself and Mr. Markey) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
  To help persons in the United States experiencing homelessness and 
significant behavioral health issues, including substance use disorder, 
  by authorizing a grant program within the Department of Health and 
  Human Services to assist State and local governments, continuums of 
  care, community-based organizations that administer both health and 
homelessness services, and providers of services to people experiencing 
homelessness, better coordinate health care and homelessness services, 
                        and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Homelessness and Behavioral Health 
Care Coordination Act of 2023''.

SEC. 2. FINDINGS.

     Congress finds the following:
            (1) The United States has a homelessness crisis, with more 
        than 582,000 people experiencing homelessness on a single night 
        according to the Department of Housing and Urban Development's 
        2022 Annual Homeless Assessment Report to Congress.
            (2) While the lack of affordable housing is the primary 
        driver of homelessness, behavioral health conditions, including 
        substance use disorder, can exacerbate homelessness and can 
        also be a consequence of homelessness.
            (3) Research shows that people experiencing homelessness 
        have higher rates of substance use disorder than people with 
        housing stability. Some people who experience homelessness use 
        substances to cope with the trauma and deprivations of their 
        circumstances, but substance use disorder frequently makes it 
        more difficult for people experiencing homelessness to secure 
        permanent housing.
            (4) Many individuals with substance use disorder who 
        experience homelessness have co-occurring illnesses. The 
        combined effect of physical illness, mental illness, and lack 
        of housing results in higher mortality rates for individuals 
        experiencing homelessness.
            (5) Safely and securely housing individuals who are 
        experiencing both homelessness and behavioral health issues, 
        including substance use disorder, often requires supportive 
        services and close coordination between housing and social 
        service providers, in addition to low-barrier, affordable 
        housing. Subsidized housing is critical, but not enough--access 
        to additional voluntary person-centered supportive services is 
        needed.
            (6) It is imperative that when people experiencing 
        homelessness choose to seek help that housing as well as health 
        care and person-centered supportive services be coordinated, 
        particularly given their acute needs and the significant costs 
        incurred by communities for law enforcement, correctional, and 
        emergency department care for failing to do so.
            (7) While participation in health care and person-centered 
        supportive services should not be a requirement for people 
        experiencing homelessness to receive housing, access to such 
        services can be beneficial in securing and successfully 
        maintaining stable housing.
            (8) Integration of health and homelessness services to 
        achieve optimal outcomes for people experiencing homelessness, 
        significant behavioral health conditions such as substance use 
        disorder, and other health conditions can be challenging for 
        State and local governments, continuums of care, and community-
        based organizations that administer both health and 
        homelessness services and providers of homelessness services.
            (9) Capacity-building is needed to create systems-level 
        linkages between the 2 sets of services to allow for smoother 
        pathways and simpler navigation.
            (10) Black, Hispanic, and Indigenous people are 
        disproportionately underserved by person-centered supportive 
        services. In order to address critical services deficits and 
        affirmatively serve protected classes of people with 
        significant behavioral health conditions, including substance 
        use disorder, who are experiencing homelessness, the grant 
        program established under this Act can be used to build the 
        capacities of providers of homelessness services that have 
        demonstrated cultural competencies in service provision and a 
        record of serving Black, Hispanic, and Indigenous people and 
        other underserved populations experiencing homelessness that 
        also suffer from substance use disorder.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) Behavioral health.--The term ``behavioral health'' 
        includes mental health and substance use.
            (2) Eligible entity.--The term ``eligible entity'' means an 
        entity described in section 3(c)(4) that is eligible for a 
        competitive grant under section 4.
            (3) Indian tribe.--The term ``Indian Tribe'' has the 
        meaning given the term in section 4 of the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 5304).
            (4) Person experiencing homelessness.--The term ``person 
        experiencing homelessness'' has the same meaning as the terms 
        ``homeless'', ``homeless individual'', and ``homeless person'', 
        as defined in section 103 of the McKinney-Vento Homeless 
        Assistance Act (42 U.S.C. 11302).
            (5) Public housing agency.--The term ``public housing 
        agency'' has the meaning given the term in section 3(b)(6) of 
        the United States Housing Act of 1937 (42 U.S.C. 1437a(b)(6)).
            (6) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (7) Substance use disorder.--The term ``substance use 
        disorder'' means the disorder that occurs when the recurrent 
        use of alcohol or drugs, or both, causes clinically significant 
        impairment, including health problems, disability, and failure 
        to meet major responsibilities at work, school, or home.
            (8) Tribal organization.--The term ``Tribal 
        organization''--
                    (A) has the meaning given the term in section 4 of 
                the Indian Self-Determination and Education Assistance 
                Act (25 U.S.C. 3504); and
                    (B) includes entities that serve Native Hawaiians, 
                as defined in section 338K(c) of the Public Health 
                Service Act (42 U.S.C. 254s(c)).
            (9) Tribally designated housing entity.--The term 
        ``tribally designated housing entity'' has the meaning given 
        the term in section 4 of the Native American Housing Assistance 
        and Self-Determination Act of 1996 (25 U.S.C. 4103).

SEC. 4. ESTABLISHMENT OF GRANT PROGRAM.

    (a) In General.--The Secretary, in consultation with the working 
group established under subsection (b), shall establish a grant program 
to award competitive grants to eligible entities in direct coordination 
with a continuum of care to build or increase capacity to coordinate 
the delivery of health care and homelessness services within the 
continuum of care.
    (b) Working Group.--
            (1) Establishment.--The Secretary shall establish an 
        interagency working group to provide advice and coordinate 
        along relevant existing working groups to the Secretary in 
        carrying out the program established under subsection (a).
            (2) Composition.--The working group established under 
        paragraph (1) shall include representatives from the Department 
        of Health and Human Services, the Department of Housing and 
        Urban Development, the United States Interagency Council on 
        Homelessness, the Department of Agriculture, and the Bureau of 
        Indian Affairs, to be appointed by the heads of such agencies.
            (3) Development of assistance tools.--Not later than 1 year 
        after the date of enactment of this Act, the working group 
        established under paragraph (1) shall--
                    (A) develop training, tools, and other technical 
                assistance materials that simplify homelessness 
                services for providers of health care and simplify 
                health care services for providers of homelessness 
                services by identifying the basic elements the health 
                and homelessness sectors need to understand about the 
                other; and
                    (B) circulate the materials described in 
                subparagraph (A) to interested entities, particularly 
                eligible entities that apply for grants awarded 
                pursuant to this Act.
    (c) Capacity-Building Grants.--
            (1) In general.--The Secretary shall award 5-year grants to 
        eligible entities, which shall be used only to build or 
        increase capacities to coordinate health care and homelessness 
        services.
            (2) Prohibition.--None of the proceeds from the grants 
        awarded pursuant to this Act may be used to pay for--
                    (A) health care, with the exception of efforts to 
                increase the availability of Naloxone and provide 
                training for the administration of Naloxone; or
                    (B) rent.
            (3) Amount.--The amount awarded to an eligible entity under 
        a grant under this subsection shall not exceed $500,000.
            (4) Eligibility.--To be eligible to receive a grant under 
        this subsection, an entity shall--
                    (A) be designated by a continuum of care to ensure 
                coordination across the continuum of care geographic 
                regions, and which may be--
                            (i) a governmental entity at the county, 
                        city, regional, or locality level;
                            (ii) an Indian Tribe, a tribally designated 
                        housing entity, a Tribal organization, or an 
                        urban Indian organization;
                            (iii) a public housing agency administering 
                        housing choice vouchers; or
                            (iv) a nonprofit organization;
                    (B) be responsible for homelessness services;
                    (C) provide such assurances as the Secretary shall 
                require that, in carrying out activities with amounts 
                from the grant, the entity will ensure that services 
                are culturally competent, meet the needs of the people 
                being served, and follow trauma-informed best practices 
                to address those needs using a harm reduction approach; 
                and
                    (D) demonstrate how the capacity of the entity to 
                coordinate health care and homelessness services to 
                better serve people experiencing homelessness and 
                significant behavioral health issues, including 
                substance use disorder, can be increased through--
                            (i) the designation of a governmental 
                        official as a coordinator for making 
                        connections between health and homelessness 
                        services and developing a strategy for using 
                        those services in a holistic way to help people 
                        experiencing homelessness and behavioral health 
                        conditions such as substance use disorder, 
                        including those with co-occurring conditions;
                            (ii) improvements in infrastructure at the 
                        systems level;
                            (iii) improvements in technology for 
                        voluntary remote monitoring capabilities, 
                        including internet and video, which can allow 
                        for more home- and community-based behavioral 
                        health care services and ensure such 
                        improvements maintain effective communication 
                        requirements for persons with disabilities and 
                        program access for persons with limited English 
                        proficiency;
                            (iv) improvements in connections to health 
                        care services delivered by providers 
                        experienced in behavioral health care and 
                        people experiencing homelessness;
                            (v) efforts to increase the availability, 
                        and training for the administration, of opioid 
                        antagonists indicated for emergency treatment 
                        of opioid overdose; and
                            (vi) any additional activities identified 
                        by the Secretary that will advance the 
                        coordination of homelessness assistance, 
                        housing, and behavioral health care services 
                        and other health care services.
            (5) Eligible activities.--An eligible entity receiving a 
        grant under this subsection may use the grant to cover costs 
        related to--
                    (A) hiring system coordinators; and
                    (B) administrative costs, including staffing costs, 
                technology costs, and other such costs identified by 
                the Secretary.
            (6) Distribution of funds.--An eligible entity receiving a 
        grant under this subsection may distribute all or a portion of 
        the grant amounts to private nonprofit organizations, other 
        government entities, State, local, or Tribal public health 
        departments, community health centers or organizations, public 
        housing agencies, tribally designated housing entities, or 
        other entities as determined by the Secretary to carry out 
        programs and activities in accordance with this section.
            (7) Oversight requirements.--
                    (A) Annual reports.--Not later than 6 years after 
                the date on which grant amounts are first received by 
                an eligible entity, the eligible entity shall submit to 
                the Secretary a report on the activities carried out 
                under the grant, which shall include, with respect to 
                activities carried out with grant amounts in the 
                community served--
                            (i) measures of outcomes relating to 
                        whether people experiencing homelessness and 
                        significant behavioral health issues, including 
                        substance use disorder, who sought help from an 
                        entity that received a grant--
                                    (I) were housed and did not 
                                experience intermittent periods of 
                                homelessness;
                                    (II) were voluntarily enrolled in 
                                treatment and recovery programs;
                                    (III) experienced improvements in 
                                their health;
                                    (IV) obtained access to specific 
                                primary care providers; and
                                    (V) have health care plans that 
                                meet their individual needs, including 
                                access to mental health and substance 
                                use disorder treatment and recovery 
                                services;
                            (ii) how grant funds were used; and
                            (iii) any other matters determined 
                        appropriate by the Secretary.
                    (B) Rule of construction.--Nothing in this 
                subsection may be construed to condition the receipt of 
                future housing and other services by individuals 
                assisted with activities and services provided with 
                grant amounts on the outcomes detailed in the reports 
                submitted under this subsection.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $20,000,000 for each of fiscal 
years 2023 through 2028, of which not less than 5 percent of such funds 
shall be awarded to Indian Tribes, tribally designated housing 
entities, and Tribal organizations.
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